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NPI Code Detail

MEDICARE: MARYAM MAGHSOUDLOO

MEDICARE: MARYAM MAGHSOUDLOO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDN1857773MA

General Provider Information

NPI Number : 1427567783
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARYAM MAGHSOUDLOO
Provider Business Mailing Address
First Line : 3920 MYSTIC VALLEY PKWY APT 109
Second Line :
City : MEDFORD
State : MA
Zip : 02155-6900
Country : US
Telephone Number : 857-707-5144
Fax Number :
Provider Business Practice Location Address
First Line : 1201 BRIDGE ST
Second Line :
City : LOWELL
State : MA
Zip : 01850-1293
Country : US
Telephone Number : 978-455-7056
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/29/2017
Last Update Date : 09/29/2017

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Directions to “ MARYAM MAGHSOUDLOO ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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